AB0341 COMPARISON OF CANDIDATE KEY FACTORS FOR INCIDENT FRAGILITY FRACTURE IN POSTMENOPAUSAL FEMALE PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: I. Yoshii, N. Sawada, T. Chijiwa, S. Nishiyama
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Bone fragility fracture (BFF) in patients with rheumatoid arthritis (RA) is still a significant comorbidity that deteriorates the quality of life after that. Some reports clarified risk factors and the keys to preventing them. <h3>Objectives</h3> The aim of this study is to evaluate the factors statistically and advocate a novel key to preventing the incidence of BFF. <h3>Methods</h3> A retrospective cohort study data was used. Postmenopausal RA patients were picked up. They have been treating RA and measured bone mineral density (BMD) with dual-energy X-ray absorptiometry. The initial target of therapy is the attainment of remission with SDAI within 6 months of initiation. The primary outcome was incident BFF (inc-BFF). Follow-up started at BMD measurement (baseline) and continued until the development of the first fracture or censoring at death, loss to follow-up or end of the study. In these subjects, T-scores and pr-BFF were combined, and T-score &lt; -2.5 in the lumbar spine (LS) or femoral neck (FN), or presence of pr-BFF was evaluated as primary osteoporosis criteria matched (pr-OP). Potential key factors for incident BFF, such as age, disease duration of RA, anti-citrullinated polypeptide antibodies (ACPA), rheumatoid factor (RF), remission rate using clinical disease activity index (CDAIRR), C-reactive protein, Health Assessment Questionnaire Disability Index, pain score using a visual analog scale (PS-VAS), vector value of coordinate on X-axis and Y-axis (Vxy) using Joint Index Vector (JIV), body mass index (BMI), presence of comorbidities such as hyper-fallability (Fall), lifestyle-related diseases (LSD), cognitive impairment (CI), estimated glomerular filtration rate calculated with cystatin C (eGFR_CysC), anti-osteoporotic drug administration and glucocorticoid administration, and serum albumin level (ALB) were chosen as variants. Receptor operation characteristics (ROC) curve was examined for each variant in regard to inc-BFF and the Cut-off index (COI) for each variant was determined. A Cox regression analysis with a multivariate mode in the variants that had statistical significance with the ROC. Kaplan-Meier survival curve (K-M) was examined for each variant in regard to COI. Finally, the K-M study examined the chi-square test by dividing it into positive pr-OP, positive all single significant variants, and positive combined conditions, and simultaneously calculated inc-BFF rates for each subgroup. Differences in BFF rates were compared for each matching pair. Statistical significance was set at less than 5% for all statistical methods. <h3>Results</h3> A total of 239 patients were recruited. The mean age was 73.6 years and the mean follow-up period was 52.4 months. In the ROC study, pr-OP, ACPA, CDAIRR, PS-VAS, Vxy, Fall, LSD, CI, eGFR_CysC, and ALB demonstrated statistical significance with the COI of presence, 0.9 (U/mL), 0.52, 25.0 (mm), 0.012, presence, presence, presence, 50.7 (ml/min/1.41m2), and 4.0 (g/dL), respectively. In these, PS-VAS, Vxy, and ALB had significant risk ratios with values of 1.04, 0.07, and 0.20, respectively. Hazard ratios of each variant in the K-M study were 3.51, 4.56, and 1.81, however, p-values were &lt;0.001, &lt;0.01, and 0.07 for PS-VAS, Vxy, and ALB, respectively. The BFF rate in the pr-OP and PS-VAS ≥ 25.0 subgroups were 4.5%, 12.9%, 14.7%, and 37.9% in the negative/negative, negative/positive, positive/negative, and positive/positive groups, respectively, whereas the BFF rate in the pr-OP and Vxy ≥ 0.012 subgroups were 4.3%, 8.3%, 6.3%, and 32.4% in the negative/negative, negative/positive, positive/negative, and positive/positive group, respectively, When PS-VAS and Vxy were combined to matching either of these, the BFF rate in the subgroups were 5.6%, 12.5%, 12.8%, and 49.0% in the negative/negative, negative/positive, positive/negative, and positive/positive group, respectively. <h3>Conclusion</h3> These results suggest that Vxy &gt; 0.012 and PS-VAS &gt; 25 mm are available risk indicators for inc-BFF. The composite indicator should be more predictable. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.